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Problems in school are rarely well understood by parents, and often are misunderstood by teachers and physicians as well. Poor grades usually are blamed on laziness, low intelligence, or a “learning disability.” Behavior problems are usually blamed on “bad attitudes” or being “spoiled.” While these causes may occasionally exist, in most cases they are not the true cause of poor grades in school.

In most cases poor grades and behavior problems are due to either:
·         Attention deficit disorder
·         Clinical depression
·         Anxiety

Let’s discuss each of these briefly, as they apply to students. Then, we’ll say something about “laziness, low intelligence, learning disability, bad attitudes and being spoiled” as causes of poor grades and behavior problems.

Attention deficit disorder (ADD)
No condition is more controversial these days than ADD. Even many physicians don’t fully understand it. There are fears among parents that ADD is being over-diagnosed and children unnecessarily medicated. However, the true facts are actually reassuring.

In the year 2000 the National Institute of Health (NIH), a branch of the federal government, completed a comprehensive review of the scientific evidence regarding ADD. The NIH concluded that:
·         ADD does in fact exist as a clinical disorder
·         ADD can be reliably diagnosed by experts
·         Proper medications can dramatically improve ADD
·         Many physicians are not properly diagnosing or treating ADD

In essence, the NIH said that ADD is real and treatable, but that great expertise should be used in diagnosing and treating ADD.

The most common symptoms of ADD include:
·         Short attention span for non-entertaining but important activities
·         Quick boredom
·         Being easily distracted away from important tasks
·         Difficulty listening well (daydreams during class lecture)
·         Poor memory for non-entertaining tasks (forgets to turn in
      completed homework; forgets two of three items on a to-do list)
·         Puts off tasks to the last minute
·         Starts many projects, but leaves most unfinished
·         Poor memory of what was read (cannot answer questions
      over reading material)
·         Poor impulse control (speaks or acts impulsively without
      thinking through the consequences)
·         Impatience and intolerance of waiting
·         Irritability and angry outbursts
·         Brief, sudden “mood swings;” gets overly excited, or
      overly “down” or angry
·         Fidgety, restless, hyperactive

Most students with ADD will have three or four of these symptoms, especially the first three. The symptoms will be apparent in more than one subject, and usually are present away from school, too. The symptoms do not suddenly appear and then disappear; rather, they form the student’s “personality.”

Academically, students with ADD may rush through schoolwork without applying their full concentration and knowledge to the work. They tend to be distracted away from class work and homework by minor things. They may have problems finishing work during class, and homework that should take 30 minutes to complete may take an hour and a half because of poor attention and concentration. They tend to procrastinate school projects until the last possible moment. They tend to wait to study for tests until the night before. They find most schoolwork painfully boring, often to the point that they cannot keep their mind on it. (On the other hand, if a particular school subject (or hobby) interests the student greatly, she may fully apply her concentration and attention without procrastination and do very well. This is because she finds this particular activity entertaining.)

Eventually, these problems affect the student’s grades. With more severe ADD, grades may be low starting in elementary school. Commonly, students with ADD will begin to have more trouble with grades starting in middle school or junior high when work is more independent and less entertaining. With less severe ADD (combined with high intelligence) the student may be able to make “good” grades in spite of these symptoms even all the way through high school, and then begin to have problems in college where the work is much more demanding.

Students do not have to have hyperactivity to have ADD. This is a key point and represents a change in the diagnosis of ADD over the past 15 years. Many parents, teachers, (and physicians) still think that without hyperactivity a student cannot have ADD. We now know that students can be very quiet, socially reserved and still have ADD. If hyperactivity is present, the condition is called ADHD: Attention deficit, hyperactivity disorder. The treatment of ADD and ADHD are almost identical.

If a child has ADHD, usually the parents will hear during elementary school that their child is having “behavior problems.” This may be merely talking too much during class, or simply being too fidgety in his desk. With more severe ADHD, the student may run and jump in class and the hallways, and may also be too aggressive with inappropriate teasing or even fighting. With even more severe ADHD, stealing or troublesome sexual behaviors may occur—due to impulse control problems.

With simple ADD none of these behavior problems may exist.

ADD is usually hereditary, and is due to low functioning of a normal brain chemical called dopamine. It is safely treatable with medications that increase dopamine. For complete information about ADD/ADHD, please see our brochure Attention Deficit Disorder or to hear a 4-minute recording on ADD call 271-6808.

Clinical depression
Clinical depression is a less common cause of school problems. It’s even less well recognized than ADD. The most common symptoms of clinical depression include:
·               A feeling of sadness or a “blue” feeling
·               Tiredness, fatigue
·               Irritability, excessive anger, temper outbursts
·               Low self-esteem, self-criticism
·               Too tearful, excessive crying
·               Loss of motivation, low enthusiasm
·               Loss of enjoyment, little fun, little pleasure
·               Sleep disorders—too little or too much
·               Appetite disorders—too much or too little
·               Withdrawal from family, friends, co-workers
·               Poor concentration, difficulty making decisions
·               Loss of creativity, difficulty solving problems
·               Anxiety, nervousness, panic attacks
·               Chronic aches and pains, gastrointestinal disorders
·               Suicidal thoughts or wishes for death

The primary symptoms of clinical depression depend on the age of the student.

In elementary school students clinical depression usually presents as easy tearfulness, whining, sleep difficulties, poor effort at schoolwork, and fear of separation from mother.

In teens clinical depression usually presents as anger outbursts, social withdrawal or switching to a “lower functioning” group of friends, and often a fall in grades. In addition, the student may be dramatically less interested in recreational activities, preferring to “be alone.”

In college students clinical depression presents as is typical for young adults. Low self-esteem, low energy, difficulty concentrating, changes in sleep and appetite, and constant negative thoughts.

In most cases of clinical depression, the symptoms have a rather clear onset; for example, a definite change in personality for the worse over the past 3 months. The teacher (or parent) may say, “What’s going on? She was so studious last term, and now she acts like she doesn’t care about her grades.” This helps to differentiate clinical depression from ADD. There may or may not be an obvious “reason” why the student is depressed (often the reason is genetic and biochemical).

Clinical depression is also very treatable. Counseling can be used to help the student become less depressed, and the antidepressant medications can also be used. The antidepressant medications have been in existence for 40 years, and have been found to be very safe and non-addictive. The medications increase brain levels of two normal biochemicals, serotonin and norepinephrine, which are often low in persons with clinical depression.

For more complete information see our page on Clinical Depression. To hear a 4-minute recording on clinical depression call 271-6808.

Anxiety Disorders
These disorders are also somewhat less common among students than is ADD. Among the public, and even among medical professionals, this may be the least well understood cause of school problems.

The typical symptoms of anxiety disorders include:

Nervousness or fearfulness

Strange thoughts or perceptions

Tremors

Pounding heartbeat

Increased Urination

High blood pressure

Sweating

Difficulty breathing

Hot flashes or cold chills

Racing thoughts

Confusion

Insomnia

Stomach upset

Fast heartbeat

Dizziness

Chest pain
Restlessness

Difficulty swallowing

Compulsive behaviors

The typical presentation of anxiety disorders depends on the student’s age.

In elementary students anxiety is often manifested by school phobia: terror at separation from the parent at the bus, car, or classroom. Unexplained stomach aches and headaches are also common. Fear of sleeping alone is common, too. Often, the child will have social anxiety and be afraid of meeting other children in settings other than school, too. The child my have obsessive-compulsive symptoms such as irrational counting, repeating, or over-organizing.

In teenagers and college students outright school phobia is rare, but social phobia with extreme shyness is common, as is fear of any type of public performance. The student may avoid Speech Class, for example. Dating may be very frightening, and the student may worry excessively about trivial things. Dysmorphobia is common, with irrational beliefs that a body part is deformed or ugly, with resulting extreme worry and preoccupation about it. Obsessive-compulsive counting, cleaning, organizing, repeating and checking are also common.

Unlike clinical depression, anxiety disorders tend to be long-lasting with periods of improvement and periods of worsening, often during more stressful times. The cause in students seems usually to be heredity.

Anxiety disorders are also very treatable with counseling and sometimes medications. For more information, see our handout Anxiety Disorders or call 271-6808 for a brief informational recording.

About laziness, bad attitudes, low intelligence, “spoiled”

Yes, these characteristics exist, but they are far less commonly the cause of school problems than are ADD, Clinical Depression, and Anxiety Disorders. These characteristics should not be quickly assumed to be the cause of a student’s problems.

Laziness, bad attitudes, and being spoiled respond to proper teacher and parental discipline. ADD, clinical depression, and anxiety disorders do not; at least not for long at a time. This non-response is usually puzzling and frustrating to the teachers and parents.

Low intelligence usually affects all parts of a student’s life. He will have been slow to achieve the normal developmental milestones: crawling, pulling up, walking, talking, etc. He will seem slow in most all activities of life. Students with ADD, clinical depression, or anxiety disorders will show normal capabilities in most areas of life most of the time (e.g., video games or mechanical tasks that they find interesting).

Learning disabilities are limited to one particular type of learning, say mathematics. In all other areas the student will do well. Children with ADD are often diagnosed as having learning disabilities (which often disappear when the ADD is treated!).

When should you seek a professional evaluation?
When a student has shown the symptoms of ADD, clinical depression, or anxiety disorders for more than four weeks, and the symptoms are interfering with academic performance or socializing, then an evaluation should be sought. When a student has demonstrated academic or behavioral problems for more than 4 weeks and he or she has not shown improvement with standard discipline, then an evaluation should be sought. Not to seek an evaluation in these situations is short-changing the student, the family, and the school.

Who should perform the evaluation?
A medical specialist with great training and experience in these disorders should perform the evaluation. Differentiating these disorders from normal behavior or other medical conditions can be difficult. The treatment of these conditions is very specialized.

About Tate Healthcare Specialists
We are specialists in treating ADD, Clinical Depression, Anxiety Disorders, Obesity, and Alzheimers. Our physicians are board-certified, and all of our clinical staff has many years of experience. We have rightfully gained the reputation as the experts in these conditions in northwest Arkansas.Most health insurance will reimburse 50% to 80% of our fee. By the way, a recent health insurance audit showed our costs of care to be 35% less than similar specialists in Arkansas. I believe this is because we are dedicated to fast, accurate diagnosis and quickly effective care.

Fore more information about our clinic and staff, please see our brochure Feel Better, Achieve More. For more information about these conditions, please listen to our 4-minute recordings about them at 800-889-4319. You can call that number to make and appointment, or you can click Request an Appointment. If you would like free feedback about your condition click Free Symptom Analysis. Thank you!